Abstract
Background
Laparoscopic Heller myotomy was first undertaken in the early 1990s, and appreciable numbers of patients with 10-year follow-up periods are now available. This study was undertaken to determine long-term outcomes after laparoscopic Heller myotomy used to treat achalasia.
Methods
Of 337 patients who have undergone laparoscopic Heller myotomy since 1992, 47 who underwent myotomy more than 10 years ago have been followed through a prospectively maintained registry. Among many symptoms, patients scored dysphagia, chest pain, vomiting, regurgitation, choking, and heartburn before and after myotomy using a Likert scale with choices ranging from 0 (never/not bothersome) to 10 (always/very bothersome). Symptom scores before and after myotomy were compared using a Wilcoxon matched-pairs test. Data are reported as median (mean ± standard deviation).
Results
The median length of the hospital stay was 2 days (mean, 3 ± 8.6 days; range, 1–60 days). Notable complications were infrequent after myotomy. There were no perioperative deaths. One patient required a redo myotomy after 5 years due to recurrence of symptoms. At this writing, 33 patients (70%) are still alive. The causes of death after discharge were unrelated to myotomy. The frequency and severity scores for dysphagia, chest pain, vomiting, regurgitation, choking, and heartburn all decreased significantly after laparoscopic Heller myotomy (p < 0.0001 for all).
Conclusions
Laparoscopic Heller myotomy can be undertaken with few complications. This procedure significantly decreases the frequency and severity of achalasia symptoms without promoting heartburn. The symptoms of achalasia are durably ameliorated by laparoscopic Heller myotomy during long-term follow-up evaluation, thereby promoting application of this procedure.
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References
Shimi S, Nathanson LK, Cuschieri A (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36:152–154
Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after Botox or dilation. Ann Surg 241:725–733
Bloomston M, Serafini F, Rosemurgy AS (2001) Videoscopic Heller myotomy as first-line therapy for severe achalasia. Am Surg 67:1105–1109
Torquati A, Lutfi R, Khaitan L, Sharp KW, Richards WO (2006) Heller myotomy vs Heller myotomy plus Dor fundoplication: cost-utility analysis of a randomized trial. Surg Endosc 20:389–393
Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–593
Mayberry JF (2001) Epidemiology and demographics of achalasia. Gastrointest Endosc Clin North Am 11:235–248
Bloomston M, Boyce W, Mamel J, Albrink M, Murr M, Durkin A, Rosemurgy A (2000) Videoscopic Heller myotomy for achalasia: results beyond short-term follow-up. J Surg Res 92:150–156
Bloomston M, Brady P, Rosemurgy AS (2002) Videoscopic Heller myotomy with intraoperative endoscopy promotes optimal outcomes. J Soc Laparoendosc Surg 6:133–138
Bloomston M, Rosemurgy AS (2002) Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 12:309–315
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240:405–412
Devaney EJ, Lannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72:854–858
Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833
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Cowgill, S.M., Villadolid, D., Boyle, R. et al. Laparoscopic Heller myotomy for achalasia: results after 10 years. Surg Endosc 23, 2644–2649 (2009). https://doi.org/10.1007/s00464-009-0508-1
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DOI: https://doi.org/10.1007/s00464-009-0508-1